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HospitalistWeekly 11-5-08
Highlights
- ED unit improves outcomes by sending overflow to inpatient hallways
- PCI has helped reduce deaths from cardiogenic shock
- Survey reveals patients' perceptions of U.S. hospital care
Clinical guidelines
- Geneva scoring simplified for pulmonary embolism
From ACP Hospitalist
From ACP Internist
- On the blog: News from MGMA, CHEST 2008
Cartoon caption contest
- Put words in our mouth
Highlights
.ED unit improves outcomes by sending overflow to inpatient hallways
Emergency patients moved from the emergency department to inpatient units' hallways had less than half the mortality and intensive care unit admission rates of patients boarded in normal rooms, a recent study reported.
Study results of 57,487 patients admitted to the hospital from the emergency department during a four-year study period were presented at the annual meeting of the American College of Emergency Physicians. Admitted patients were moved to in-patient hallways if they were stable, there were more than three admitted patients already boarded in the emergency department and there was no space to see incoming emergency patients.
Researchers assessed admissions to Stony Brook University Hospital between January 2004 and January 2008. Although patients sent to inpatient hallways had longer wait times from triage to admission, their mortality rates were 1.1%, compared with 2.5% for patients admitted to normal rooms. Further, ICU admissions were higher in the standard bed admissions at 6.9% vs. 2.6% of patients admitted to inpatient hallways. Robert Wood Johnson Foundation profiled the effort here and ACP Hospitalist addressed the topic in its February 2007 issue.
Robert Wood Johnson Foundation profiled two other efforts. Straight Back Triage at William Beaumont Hospital; Royal Oak, Mich., reduced crowding and wait times in the emergency department via a new triage system to quickly pre-screen and categorize patients before sending them to one of three treatment areas to be more fully triaged.
Decreasing ED Throughput Time by Using a Discharge Resource Room at the Regional Medical Center at Memphis, Tenn., showed how 60% of all medical/surgical patients are now discharged from an eight-bed area dedicated to providing discharge instructions and resources for inpatients to assist in preparation for their home care. This provides an inpatient bed more rapidly and has had a significant effect on decreasing ED throughput time.
.PCI has helped reduce mortality from cardiogenic shock
Angioplasty may be reducing the incidence of cardiogenic shock by improving blood flow to the damaged heart muscle, a study in the latest Annals of Internal Medicine reports.
Researchers carefully reviewed data on more than 23,000 patients with acute coronary syndrome (ACS) in Switzerland between 1997-2006. They found that rates of cardiogenic shock on admission remained constant but the incidence of cardiogenic shock as a complication of ACS steadily decreased because fewer patients developed the condition during hospitalization. Percutaneous coronary intervention (PCI) and lipid-lowering therapy were associated with lower mortality rates among all patients with ACS.
The authors concluded that medical management, mainly PCI rates, helped lower mortality rates among patients with ACS and lower rates of cardiogenic shock development during hospitalization.
.Survey reveals patients' perceptions of U.S. hospital care
The majority of patients who completed a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey said they were satisfied with their experiences, but the survey highlighted several key areas for improvement, including pain control and discharge instructions, according to a study in the New England Journal of Medicine.
On average, 67.4% of a hospital's patients said that they would definitely recommend the hospital, said the survey, which included data on more than 2,400 hospitals nationwide. Generally, researchers found a strong correlation between high satisfaction scores and high nurse-to-patient ratios and high quality of care. For example, those in the top quartile of HCAHPS ratings performed better than those in the bottom quartile with respect to treatment of acute myocardial infarction and pneumonia.
However, the authors noted that many hospitals scored lower on pain control and discharge instructions--areas that have been targeted by quality improvement efforts--and communication about medications. They added that the study is limited because nearly 40% of the U.S. hospitals surveyed failed to provide HCAHPS data.
Clinical guidelines
.Geneva scoring simplified for pulmonary embolism
A simplified version of the Geneva score to assess the risk of pulmonary embolism retains the diagnostic accuracy of the original, according to a report in Archives of Internal Medicine.
Researchers looked at data on 1,049 patients from two large prospective diagnostic trails that included patients with suspected PE. The diagnostic accuracy between the original Geneva score and the revised version did not differ significantly and no patient with low to intermediate scores with a normal result of a D-dimer test was diagnosed with venous thromboembolism after three months.
In the simplified version, patients received one point each of the following: age over 65, history of deep venous thrombosis or pulmonary embolism, surgery under general anesthesia or lower-limb fracture within 1 month; active malignancy; unilateral lower-limb pain; hemoptysis; heart rate between 75 and 94, or 95 and above; and pain on lower-limb palpation and unilateral edema.
While the study should be confirmed in a prospective study, the authors said, the findings suggest that the simplified version does not lower diagnostic accuracy or clinical utility.
From ACP Hospitalist
.Election poll finds voters pulling for Obama's health care plan
ACP Hospitalist's poll found most of its voters pulling for the health care plan offered by Sen. Barack Obama over that of Sen. John McCain, and that the proposed health care plans formed at least part of the reason why they voted.
In the poll, 73.9% chose Mr. Obama's plan while Mr. McCain's plan drew 21.6% of voters and 4.6% were undecided. Almost 70% of voters said that the proposed health care reforms were partly why they voted (as opposed to the primary reason or not an influence). Just over 150 readers voted through ACP InternistWeekly, ACPHospitalistWeekly, the ACP Internist blog or our Web site.
Readers will quickly find out if ACP HospitalistWeekly readers are tracking with election outcomes and how much influence the candidate's health care proposals played.
This survey is not scientific and is not an endorsement of either candidate or their respective health care plans.
.The November issue is now online
The November issue of ACP Hospitalist is now online, featuring its first annual Top Hospitalists feature highlighting doctors reinventing and expanding the role of the hospitalist at their facilities. Meet the teachers, quality improvement gurus, researchers and bloggers who've focused on improving geriatric care, growing hospital admissions, facilitating transitions of care and raising staff satisfaction. Also in this issue:
Calling for backup before it’s needed. Failure to rescue, the failure to identify patients with critical abnormalities and provide the resources necessary to prevent harm, was one of the top three preventable errors found in hospitals in 2004-2006, accounting for 17% of total errors. Experts offer their solutions.
The hospitalized hospitalist. Editorial advisor James S. Newman, FACP, recalls (somewhat fuzzily) his hip transplant.
From ACP Internist
.On the blog: News from MGMA, CHEST 2008
ACP Internist's writers have crossed the country in recent weeks, reporting from conferences at the Medical Group Management Association, the American College of Chest Physicians and American College of Rheumatology. They've covered the breaking news as it happens and some hilarious minutia when it doesn't. This and Medical News of the Obvious new every Monday.
Cartoon Caption Contest
.Put words in our mouth
ACP HospitalistWeekly wants readers to create captions for this cartoon and help choose the winner.
E-mail all entries by Nov. 14. ACP staff will choose three finalists and post them in the Nov. 19 issue of ACP HospitalistWeekly for an online vote by readers. The winner will appear in the Nov. 26 issue.
Pen the winning caption and win a copy of "Medicine in Quotations," ACP's comprehensive collection of famous sayings relating to sickness and health, disease and treatment and a portrait of medicine throughout recorded history.
Test Yourself
A 52-year-old woman is evaluated for a 6-week history of generalized malaise and fatigue. She received a kidney transplant 15 years ago for hypertension-related renal failure. What type of infection is the most likely cause of this patient’s worsening kidney function?
ACP Career Connection
Looking for a new hospitalist position?
ACP Career Connection can help you find your next job in hospital medicine. Search hospitalist positions nationwide that suit your criteria and preferences. Jobs are posted about two weeks before print publication of Annals of Internal Medicine, ACP Internist, and ACP Hospitalist. Exclusive “Online Direct” opportunities are updated weekly. Check us out online.
Is Your Practice Ready For Meaningful Use?
ACP and AmericanEHR Partners are holding a free Webinar, “Meaningful Use and Its Implications For Your Practice,” featuring Dr. David Blumenthal, National Coordinator for Health Information Technology. Sign up now for this national Webinar on August 4 at 7p.m. ET
MKSAP for Students 4 and Internal Medicine Essentials for Clerkship Students 2 Package
The American College of Physicians introduces the essential book set for medical students. Get both titles for one low price!